Intraoperative Cholangiography In Laparoscopic Cholecystectomy Research Articles

A Case of Acute Pancreatitis Due to Intraoperative Cholangiography in Laparoscopic Cholecystectomy

A Case of Acute Pancreatitis Due to Intraoperative Cholangiography in Laparoscopic Cholecystectomy

Comparison of pre-operative computed tomography cholangiography and intraoperative cholangiography in laparoscopic cholecystectomy: a retrospective analysis

BackgroundThe role of intra-operative cholangiography (IOC) in laparoscopic cholecystectomy (LC) is controversial. CT cholangiography (CTC) provides a reliable assessment of biliary anatomy, potentially reducing operating times, open conversion, and complication rates. This study aims to assess the safety and effectiveness of routine pre-operative CTC.MethodsA single centre retrospective analysis was undertaken of all elective laparoscopic cholecystectomies between 2017 and 2021. Information was obtained from a general surgical database alongside hospital electronic medical records. T-tests and Chi2 tests were used to assess statistical significance.ResultsOf 1079 patients, 129 (12.0%) underwent routine pre-operative CTC, 786 (72.8%) routine IOC, and 161 patients (14.9%) neither modality. Comparing CTC and IOC, the CTC group had higher rates of open conversion (3.1% vs. 0.6%, p 0.009), subtotal cholecystectomies (3.1% vs. 0.8%, p 0.018), and length of stay (1.47 vs. 1.18 nights, p 0.015). Comparing the prior groups together against those utilising neither modality, the latter had reduced operative time (66.29 vs. 72.47, p 0.011), but increased rate of bile leak (1.9% vs. 0.4%, p 0.037) and bile duct injury (1.2% vs. 0.2%, p 0.049). Co-dependence between operative complications was noted in linear regression.ConclusionBiliary imaging with either CTC or IOC is beneficial in reducing bile leak and bile duct injury, and its routine use LC is recommended. However, routine CTC is inferior to routine IOC in preventing conversions to open surgery and subtotal cholecystectomy. Further research may be undertaken to evaluate criteria for a selective CTC protocol.

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

Routine intraoperative cholangiography (IOC) for laparoscopic cholecystectomy (LC) remains controversial. The primary outcomes of this meta-analysis were detection rates of choledocholithiasis, bile duct injuries (BDI), and missed stones in LCs. A systematic literature search was conducted for the time period January 1, 1990 to July 31, 2022. Some studies reported LCs with conversion to open therefore subgroup analysis in BDI rates was performed for studies which included LCs with and without conversion to open. Studies including primary open cholecystectomies were excluded. I2 statistics were used for heterogeneity analysis. Fourteen studies involving 440659 patients were included. In studies comparing routine and selective IOC policies in LC, 61.1% of patients underwent routine IOC; 38.9% underwent selective IOC. In studies comparing IOC to no IOC in LC, 17.3% of patients had IOC; 82.7% did not. Between the selective and routine IOC groups there was no difference in choledocholithiasis detection rate (odds ratio [OR] = 1.33, p = 0.20, 95% confidence interval [CI] = 0.86 - 2.04), no difference in the rate of missed stones (OR = 1.59, p = 0.58; 95% CI = 0.31 - 8.29), and no difference in BDI rates in selective compared to routine IOC (OR = 0.92, p = 0.92; 95% CI = 0.20 - 4.22). There was no difference in the BDI detection rates in LC with and without IOC (OR = 1.12, p = 0.77; 95% CI = 0.52 - 2.38). This is the largest meta-analysis on this topic to date. There was no statistically significant difference in choledocholithiasis detection, missed stones, or BDI rates in the analyzed groups.

Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy: a meta-analysis.

To compare indocyanine green dye fluorescence cholangiography (ICG-FC) with intra-operative cholangiography (IOC) in minimal access cholecystectomy for visualization of the extrahepatic biliary tree. Although studies have shown that ICG-FC is safe, feasible, and comparable to IOC to visualize the extrahepatic biliary tree, there is no comparative review. We searched The Embase, PubMed, Cochrane Library, and Web of Science databases up to 8 April 2020 for all studies comparing ICG-FC with IOC in patients undergoing minimal access cholecystectomy. The primary outcomes were percentage visualization of the cystic duct (CD), common bile duct (CBD), CD-CBD junction, and the common hepatic duct (CHD). We used RevMan v5.3 software to analyze the data. Seven studies including 481 patients were included. Five studies, comprising 275 patients reported higher CD (RR = 0.90, p = 0.12, 95% CI 0.79-1.03, I2 = 74%) and CBD visualization rates (RR = 0.82, p = 0.09, 95% CI 0.65-1.03, I2 = 87%) by ICG-FC. Four studies, comprising 223 patients, reported higher CD-CBD junction visualization rates using ICG-FC compared to IOC (RR = 0.68, p = 0.06, 95% CI = 0.45-1.02, I2 = 94%). Four studies, comprising 210 patients, reported higher CHD visualization rates using ICG-FC compared to IOC (RR = 0.58, p = 0.03, 95% CI 0.35-0.93, I2 = 91%). ICG-FC is safe, and it improves visualization of CHD.

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: Technique and Changing Indications

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: Technique and Changing Indications

Dual common bile duct examination with transcystic choledochoscopy and cholangiography in laparoscopic cholecystectomy for suspected choledocholithiasis: a prospective study

Detection of common bile duct (CBD) stones is a major objective of intraoperative cholangiography (IOC) in laparoscopic cholecystectomy (LC). We evaluated the feasibility and safety of the routine use of transcystic choledochoscopy following IOC (dual common bile duct examination: DCBDE), which may improve the diagnostic accuracy of CBD stones and facilitate one-stage clearance, in LC for suspected choledocholithiasis. Between May 2017 and November 2018, 38 patients with suspected choledocholithiasis were prospectively enrolled in this study, regardless of whether they underwent endoscopic sphincterotomy. Transcystic choledochoscopy was routinely attempted following IOC in LC. Five cases were excluded due to cholecystitis, bile duct anomaly, or liver cirrhosis. DCBDE was performed in the remaining 33 patients. The biliary tree was delineated by IOC in all patients. Subsequently, choledochosope was performed in 32 patients except for one who was found to have pancreaticobiliary malunion in IOC. The scope was successfully passed into the CBD in 25 (78.1%) patients. Choledochoscopy detected 3 (9.4%) cases of cystic duct stones and 4 (12.5%) cases of CBD stones which were not identified by IOC. All those stones were removed via cystic duct. There were no intra- and postoperative complications, except for two cases of wound infection and one case of a transient increase in serum amylase. DCBDE in LC is a safe and promising approach for intraoperative diagnosis and one-stage treatment of suspected choledocholithasis.

Role of Intraoperative Cholangiography in Laparoscopic Cholecystectomy in Higher Risk Patients of Bile Duct Injuries

AbstractBackground: Intraoperative Cholangiography (IOC) during Laparoscopic Cholecystectomy (LC) is a radiologic contrast-based examination of the bile duct which can represent a systemic approach to avoid Bile Duct Injuries (BDIs).Aim of Study: The aim of this study was to evaluate the protective effect of selective use of IOC during laparoscopic cholecystectomy in patients with high risk for Bile Duct Injuries (BDIs).Patients and Methods: This was a prospective study included 23 patients who presented for laparoscopic chole-cystectomy and had risk factors for bile duct injuries, under-went LC with IOC. Cases were analyzed as regard operative details and clinical outcomes.Results: Cholangiography was successful in all the cases. The mean time of IOC added to LC was 22 minutes. There was a longer LC and IOC time in cases with positive CRP, pericholecystic fluid, mucocele and pyocele with positive significant differences. Although the pre-operative data 47.8% had history of obstructive jaundice, 21.7% a mucocele cases, 17.4% a pyocele cases, pericholecystic fluid in 30.4% and dilated CBD in 65.2%, only 13% showed abnormal IOC and needed further therapies (intraoperative ERCP in 2 cases and CBD exploration in 1 case). No bile duct injury in any case.Conclusion: Intraoperative Cholangiography (IOC) was found to be safe, taking only an additional time of 22 minutes to total operative time. Although the pre-operative data, only 13% of cases needed further therapies (ERCP or CBD explo-ration). The use of IOC could be considered to improve patient safety and long term results.

Clinical application value of laparoscopic intraoperative cholangiography in laparoscopic cholecystectomy

Objective To investigate the clinical application value of the laparoscopic intraoperative cholangiography in laparoscopic cholecystectomy, and summarize the experience. Methods The clinical data of 169 cases of laparoscopic cholecystectomy intraoperative cholangiography were analyzed retrospectively. Results 169 patients were successfully completed,131 cases recovered well and no complications occurred after operation. 29 patients showed hyperamylasemia, of which 3 patients had intractable hyperamylasemia,8 patients complicated with secondary acute pancreatitis, with fasting, gastrointestinal decompression, enzyme inhibition(plus somatostatin) and acid, analgesic, anti infection, rehydration treatment after remission. Conclusion Laparoscopic cholecystectomy intraoperative cholangiography is a safe and reliable diagnostic technique, on the occurrence of biliary residual stones in prevention of postoperative prevention and timely detection of bile duct injury during operation and improves the success rate of repair of bile duct injury has important clinical value; control adaptation of intraoperative cholangiography has important clinical significance of reasonable application license. Key words: Laparoscopy; Cholecystectomy; Cholangiography; Complication

Role of intraoperative cholangiography in laparoscopic cholecystectomy.

The results of a policy of selective cholangiography were assessed in 400 patients undergoing laparoscopic cholecystectomy. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 81 patients (20 per cent) of whom 31 (38 per cent) showed definite or possible evidence of stones in the bile duct. Seventeen of the 400 patients underwent intraoperative cholangiography and the majority of these (12) were normal. After a minimum follow-up of 1 year, 17 patients (4 per cent) have had ERCP for suspected residual duct stones. Eight (2 per cent) of these revealed stones and all were successfully treated with sphincterotomy and duct clearance. Preoperative and postoperative ERCP was not associated with mortality or major morbidity. No major duct injury occurred and none was diagnosed within 2 years of operation. Routine intraoperative cholangiography is not a necessary part of laparoscopic cholecystectomy in the presence of an efficient and safe ERCP service.

Analysis of Pancreaticobiliary Ductal Union Based on Intraoperative Cholangiography in Patients Undergoing Laparoscopic Cholecystectomy

Background: In order to diagnose pancreaticobiliary maljunction (PBM), it is necessary to perform direct fluoroscopic examinations of the biliary tract system. For patients with benign biliary diseases, these examinations are performed only in selected cases, because they are generally invasive. We investigated whether intraoperative cholangiography was practicable in evaluating the presence of PBM in patients with benign biliary diseases who underwent laparoscopic cholecystectomy (LC). Method: Between March 1998 and February 2001, intraoperative cholangiography (IOCG), which is one of the direct fluoroscopic examinations, was attempted in all 100 patients who underwent LC. Results: IOCG was completed successfully in 98 patients (98.0%). No complications associated with IOCG occurred. In 13 (13.3%) of 98 patients, IOCG showed reflux of contrast medium into the pancreatic duct through a common channel. 'A long common channel' was observed in 8 cases (8.2%), suggesting the presence of PBM. Conclusion: These results suggest that IOCG in LC may be a practicable method for detecting the presence of PBM.

Results of routine intraoperative cholangiography in laparoscopic cholecystectomy

Background The use of intraoperative cholangiography (IOC) has proved controversial in both open and laparoscopic cholecystectomy (LC). Our aim was to evaluate the use of routine IOC during laparoscopic cholecystectomy over a 3-year period. Methods Laparoscopic cholecystectomy was performed in 450 patients. Preoperative endoscopic retrograde cholangiography (ERCP) was performed in 14 patients, in whom stones were removed. IOC was attempted in 436 patients and was successfully performed in 394 of these (90%). Results In 18 patients (4.6%), IOC detected bile-duct stones, in two patients a cholecystoduodenal fistula and in one a partial section of the bile duct. The cystic duct was torn in one patient. IOC gave one false-positive and one false-negative result. Conclusions In laparoscopic surgery IOC should be mandatory. It is a safe procedure that is useful to detect stones in the bile duct and to recognise bile-duct injuries during the operation.

腹腔鏡下胆嚢摘出術における術前, 術中胆道造影の意義に関する検討

腹腔鏡下胆嚢摘出術における術前, 術中胆道造影の意義に関する検討

Selective intraoperative cholangiography in laparoscopic cholecystectomy

Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P < 0.01, chi-square test). The negative predictive value of the total set of risk indicators was 100%. Following our diagnostic concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.

Cystic Duct Stones Detected During Intraoperative Cholangiography in Laparoscopic Cholecystectomy

Abstract:During intraoperative cholangiography, cystic duct stones were diagnosed in 79 of 898 consecutive patients (8.8%) who underwent laparoscopic cholecystectomy over a 45‐month period. The stones were successfully removed laparoscopically. In addition, it should be mentioned that the stones were identified and retrieved before the cholangiography was started in all but 8 of the 79 cases. Of these 79, only 27 cases (34.2%) had been diagnosed as having cystic duct stones preoperatively by intravenous cholangiography and/or endoscopic retrograde cholangiography. From the results obtained, it can be concluded that intraoperative cholangiography is mandatory to detect unsuspected retained stones not only in the common duct but also in the cystic duct during laparoscopic cholecystectomy, and also provides vital information as to biliary anatomic variations, the proximity of the cystic duct to the common duct, and the confirmation of inadvertent bile duct injury.

Laparoscopic Sonography

To determine whether laparoscopic sonography (LS) could be a valid alternative to intraoperative cholangiography (IOC) in the detection of bile duct stones and anatomical variations. Prospective, controlled study comparing LS and IOC using intraoperative findings and/or postoperative endoscopic retrograde cholangiopancreatography as the gold standard. Department of Surgery at Zürich University Hospital, Switzerland. One hundred consecutive patients undergoing laparoscopic cholecystectomy between January 1992 and January 1993. Twenty-three patients were operated on for acute cholecystitis, while the remainder experienced symptomatic bile duct stones. Ninety-six patients underwent preoperative sonography and 85 underwent intravenous cholangiography. Laparoscopic sonography was performed in all patients after dissection of the cystic duct. A 5.5-MHz sector scanner with a 360 degrees angle and an optimal depth of 1 to 4 cm was used. After LS, IOC was performed with a 4F ureteric catheter and a modern fluoroscope. Patients with bile duct stones were sent for endoscopic retrograde cholangiopancreatography postoperatively or the stones were removed laparoscopically. Unsuspected common duct stones in three patients and several small calculi in the cystic duct in one patient were detected intraoperatively. Sensitivities and specificities for the detection of bile duct calculi were 100% and 98% by LS and 75% and 99% by IOC, respectively. Anatomical variations of the extrahepatic bile ducts were detected by LS in 20 patients and by IOC in 21 patients. Laparoscopic sonography visualized variations of the hepatic arteries in 22 patients. The average time consumption for LS was 5.4 minutes (range, 2 to 12 minutes) and 16.4 minutes for IOC (range, 4 to 37 minutes). Laparoscopic sonography is a quick and reliable intraoperative diagnostic tool and could replace IOC in laparoscopic cholecystectomy. Additional trials in a larger patient population are needed for a final assessment.